Post-acute healthcare expenditure following COVID-19 hospitalization and associated social inequalities in Belgium: a matched cohort study.

BACKGROUND

COVID-19 infection and hospitalization have been associated in literature with increased post-acute healthcare expenditure, but social inequalities in this association remain largely unstudied. Therefore, this study aimed to investigate post-acute healthcare expenditure among patients hospitalized with and without COVID-19 and to identify socioeconomic and sociodemographic factors associated with increased post-acute health costs.

METHODS

A matched cohort of 10,380 patients with COVID-19 and 26,270 patients without COVID-19 hospitalized in Belgium between 14 September and 31 December 2020 was created. A health systems approach was adopted and the direct individual post-acute healthcare expenditure in the calendar year 2021 in the context of the Belgian compulsory health insurance was available from the Intermutualistic Agency. The association of socioeconomic and sociodemographic variables with post-acute healthcare costs was investigated using multivariable generalized linear models with a negative binomial distribution and a log-link function.

RESULTS

COVID-19 hospitalization was associated with 18.5% (95% confidence interval: 16.9% to 20.1%) lower healthcare costs in the calendar year following hospitalization compared to non-COVID hospitalization, because patients without COVID-19 during the pandemic might have been admitted to the hospital for more severe health conditions. Lower education level, lower income, living in a collective household, and older age were associated with higher post-acute healthcare costs among COVID-19 patients, whereas COVID-19 patients having a migration background experienced lower healthcare costs.

CONCLUSIONS

This study identified different socioeconomic and sociodemographic characteristics associated with increased post-acute healthcare expenditure among COVID-19 patients, emphasizing the vulnerability of hospitalized COVID-19 patients with lower social status.